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Old 06-05-2015
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Default nbme form 3 q8 plz any one explain it

A 45-year-old woman has increasing dyspnea and fatigue. She is pale. Hemoglobin concentration is 7.5 g/dL,
leukocyte count is 4500/mm3, and platelet count is 89,000/mm". A peripheral blood smear is shown. Based on
these findings, which of the following additional findings is most likely?
A) Antiparietal cell antibodies in serum
B) Decreased serum concentration of iron
C) Increased hemoglobin A on hemoglobin electrophoresis
2
D) Increased osmotic fragility of the erythrocytes
E) Positive direct antiglobulin test
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Old 06-06-2015
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Quote:
Originally Posted by naush View Post
A 45-year-old woman has increasing dyspnea and fatigue. She is pale. Hemoglobin concentration is 7.5 g/dL,
leukocyte count is 4500/mm3, and platelet count is 89,000/mm". A peripheral blood smear is shown. Based on
these findings, which of the following additional findings is most likely?
A) Antiparietal cell antibodies in serum
B) Decreased serum concentration of iron
C) Increased hemoglobin A on hemoglobin electrophoresis
2
D) Increased osmotic fragility of the erythrocytes
E) Positive direct antiglobulin test
i didnt see blood smear, but it definetely iron deficiency anemia(low hb, high platelet count)
so you ll see decreased concentration of iron in blood
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Old 06-06-2015
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Quote:
Originally Posted by naush View Post
A 45-year-old woman has increasing dyspnea and fatigue. She is pale. Hemoglobin concentration is 7.5 g/dL,
leukocyte count is 4500/mm3, and platelet count is 89,000/mm". A peripheral blood smear is shown. Based on
these findings, which of the following additional findings is most likely?
A) Antiparietal cell antibodies in serum
B) Decreased serum concentration of iron
C) Increased hemoglobin A on hemoglobin electrophoresis
2
D) Increased osmotic fragility of the erythrocytes
E) Positive direct antiglobulin test
This entire question hinges on the smear which obviously we can't see. I'll just tell what you'd expect to see and then you can figure out the right answer from the smear (which I assume you can see).

a) this is for pernicious anemia; would see macrocytic anemia, so large RBCs, hypersegmented neutrophils

b) Fe deficiency, look for microcytic, targetoid cells/central pallor

c) Hgb A is normal adult hemoglobin; you would not see an increase in any state of anemia, so this is simply a distractor

d) hereditary spherocytosis, look for spherocytes (RBCs without the little dimple in the middle)

e) autoimmune hemolytic anemia, look for reticulocytes, spherocytes, rbc fragments, rbc aggregates, etc.

Based on the history, I would lean toward Iron deficiency or hereditary spherocytosis. AA would come with additional neuro/psych complaints due to b12 deficiency, and the autoimmune one would probably give us some additional complaint too.
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